A microbiologic and clinical study of placental inflammation at term

Dong, Yupeng; Clair, P J St; Ramzy, Ibrahim

doi:10.1016/0020-7292(88)90371-2

Cited by 40 publications

(55 citation statements)

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“…Umbilical vasculitis appeared almost always in the most advanced cases, and in association with high mediator levels. It has been shown that high grade infiltration in placenta tissues indicates intrauterine infection with a high sensitivity 3,4 . Thus, our findings suggest that pro-inflammatory cytokines, natural cytokine inhibitors, and C-reactive protein are likely to be elevated in the fetal circulation during intrauterine infection.…”

Section: Discussionmentioning

confidence: 99%

“…Low grade leucocyte infiltration in placental tissues is a common finding in normal term deliveries 1,2 , and chorioamnionitis with high grade infiltration usually indicates intrauterine infection 3,4 . Chorioamnionitis is accompanied by high concentrations of inflammatory mediators in amniotic fluid, including pro-inflammatory cytokines (tumour necrosis factor (TNF)a, interleukin (IL)-1b, IL-6, and IL-8), and natural inhibitors of cytokines (soluble TNF receptors (p55 and p75), and IL-1 receptor antagonist (IL-1RA)) 5 -8 .…”

Section: Introductionmentioning

confidence: 99%

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Histologic chorioamnionitis and umbilical serum levels of pro‐inflammatory cytokines and cytokine inhibitors

Døllner

Vatten

Halgunset

et al. 2002

BJOG

101

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Objective To study 1. whether leucocyte infiltration in placenta tissues is associated with elevated umbilical serum levels of inflammatory mediators, and 2. whether leucocyte infiltration in the presence of neonatal disease is associated with additional increase in mediator levels.Setting University hospital.Population Two groups of women with either normal delivery (n= 82) or delivery complicated by prolonged rupture of the membranes, clinical signs of intrauterine infection or preterm labour (n= 139).Methods Umbilical cord blood and placenta tissues were collected after delivery. Placentas were classified as non‐inflamed (i.e. without leucocyte infiltration, n= 74), or as mild (n= 84), or severe chorioamnionitis (n= 63). Mediator levels were compared between groups.Results Severe chorioamnionitis was associated with elevated levels of tumour necrosis factor (TNF)α, interleukin (IL)‐1β, IL‐6, IL‐8, soluble TNF receptor p55 and p75, IL‐1 receptor antagonist (IL‐1RA), and C‐reactive protein compared with non‐inflamed placentas (all P < 0.05). No differences were found between mild chorioamnionitis and placentas without infiltration. In all, 49 babies suffered from various perinatal diseases, such as clinical sepsis, respiratory distress and asphyxia, and 172 were healthy. Severe chorioamnionitis with subsequent neonatal disease (n= 23) had higher levels of all mediators, except IL‐1β and C‐reactive protein, than severe chorioamnionitis without neonatal disease (n= 40, all P < 0.01), but severe chorioamnionitis was also accompanied by a more intense and widely distributed leucocyte infiltration when neonatal disease developed.Conclusion High grade leucocyte infiltration in placenta tissues is associated with elevated levels of TNFα, IL‐1β, IL‐6, IL‐8, p55, p75, IL‐1RA and C‐reactive protein in umbilical serum. The presence of neonatal disease is associated with advanced chorioamnionitis, and highly elevated levels of both pro‐ and anti‐inflammatory mediators in umbilical serum.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Histologic chorioamnionitis and umbilical serum levels of pro‐inflammatory cytokines and cytokine inhibitors

Døllner

Vatten

Halgunset

et al. 2002

BJOG

101

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“…3 Only two previous studies have addressed the relationship of amniotic fluid (AF) microbiology to histopathologic inflammation. 6,7 The first study 6 was limited by the transcervical method of AF collection, for which there is an inherent risk of contamination. The membranes in this study were ruptured.…”

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confidence: 99%

Relationship of Amniotic Fluid Markers of Intra-Amniotic Infection With Histopathology in Cases of Preterm Labor With Intact Membranes

et al. 1999

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OBJECTIVE:To evaluate the correlation of amniotic fluid (AF) markers (AFMs) of intra-amniotic infection with histopathologic findings in cases of preterm labor with intact membranes, between 22 and 36 weeks' gestation. STUDY DESIGN:We reviewed the charts of patients admitted in preterm labor with intact membranes between January 1993 and December 1996. Those having amniocentesis were identified, and AFMs were compared with histopathology in patients who delivered within 48 hours of the amniocentesis. The AFMs evaluated were glucose, polymorphonuclear leukocytes, Gram stain, and culture. All placentae were reviewed by a single pathologist blinded to the AF findings. Histologic evidence of acute inflammation was defined by findings of both subchorial intervillositis and marginating choriodeciduitis. The sensitivities, specificities, and positive and negative predictive values of the various AFMs were calculated. RESULTS:Of 556 women with intact membranes presenting in preterm labor, 181 (32.6%) had amniocentesis and 88 delivered within 48 hours of the amniocentesis. Histopathologic chorioamnionitis was seen in 53 patients (60.2%). The findings (with their sensitivity, specificity, and positive and negative predictive values) were: polymorphonuclear leukocytes at Ͼ10/ high-power field (22.6%, 97.2%, 92.3%, and 46.1%), positive Gram stain (26.4%, 94.6%, 87.5%, and 47.3%), culture (28.3%, 92.1%, 83.3%, and 47.9%), and glucose of Ͻ15 mg/dl (28.3%, 94.6%, 88.2%, and 47.9%), respectively. Using a receiver-operator characteristic curve for different levels of AF glucose, a glucose level of Ͻ20 mg/dl was the most sensitive AF predictor of histologic chorioamnionitis. CONCLUSION:Histopathologic evidence of chorioamnionitis was present in 60.2% of cases of preterm births due to preterm labor in women who at our institution were offered and accepted amniocentesis and subsequently delivered within 48 hours. AFMs may be useful predictors of histologic chorioamnionitis. The most efficient AFM for chorioamnionitis in this group of patients was glucose at Ͻ20 mg/dl.Histologic chorioamnionitis has been associated with preterm labor and preterm births. 1-3 Although histologic inflammation is suggestive of intra-amniotic microbial invasion, the results of the few studies available are inconsistent. In some of these studies, the microbial invasion was evaluated only in the placenta and not in the amniotic cavity. [3][4][5] Histologic chorioamnionitis has been strongly associated with positive cultures of the chorioamnion. 3 Only two previous studies have addressed the relationship of amniotic fluid (AF) microbiology to histopathologic inflammation. 6,7 The first study 6 was limited by the transcervical method of AF collection, for which there is an inherent risk of contamination. The membranes in this study were ruptured. The second study used AF culture as the only method of identifying microbial invasion of the AF. 7 The aim of this study was to determine the relationship of several AF markers (AFMs) of intra-amniotic infection (IA...

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“…A few studies have addressed this question (13,(15)(16)(17)(18), but there have been no recent rigorous investigations of this question. Some of these studies report chorioamnionitis, but the technology to identify bacteria was not available.…”

mentioning

confidence: 99%

“…Many different organisms have been identified from intrauterine tissues after preterm labor using various sampling and culture techniques (12)(13)(14), but no clear pattern has emerged from these studies, so it has not been possible to implicate one particular organism or family of organisms as the main causes of preterm labor. Furthermore, it has not been proved that the bacteria present in the vagina are those that have caused chorioamnionitis in preterm labor.…”

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confidence: 99%

Bacteria and Inflammatory Cells in Fetal Membranes Do Not Always Cause Preterm Labor

et al. 2005

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Intrauterine infection has been frequently linked with preterm labor before 30 wk of human pregnancy. Many different species of organisms have been detected, leading to the suggestion that infection-induced preterm labor is a generic inflammatory response to organisms rather than a specific response to a limited number of pathogens. The detection of organisms by microbiological culture is a laborious and unreliable process, so the aim of this study was to harness modern molecular techniques to detect organisms in tissues from human pregnancy. A DNA probe specific for conserved regions of bacterial 16S ribosomal RNA sequence was designed and labeled with fluorescein for fluorescence in situ hybridization. Organisms were detected in the great majority (Ͼ80%) of fetal membranes after prolonged premature rupture of the fetal membranes and after preterm labor, which was consistent with previous data. Organisms were also detected in fetal membranes after preterm delivery without labor and in term deliveries (with or without labour). Inflammatory cells were found frequently in the amnion or chorion of preterm fetal membranes but not in term tissues. Our primary finding is that fluorescence in situ hybridization is an appropriate method to detect organisms in human fetal membranes. In addition, our data show that bacteria may be present in fetal membranes without necessarily causing an inflammatory response, so the mere presence of bacteria may not be sufficient to cause preterm labor. Human labor at all gestational ages involves an inflammatory response, being characterized by increased levels of prostaglandins and cytokines (1,2). This inflammation is presumed to be initiated by physiological mediators, including corticotrophin-releasing hormone (3) or platelet-activating factor (4), or by pathological processes (5-7).At 23-32 wk of pregnancy, preterm labor is most frequently associated with micro-organisms within the uterus (8). These organisms are thought to activate inflammatory responses within intrauterine tissues and cause the recruitment of leukocytes to the fetal membranes (chorioamnionitis) (9,10). This is so thoroughly accepted that in some studies, chorioamnionitis has been used as being diagnostic of intrauterine infection, without determination of the presence of bacteria (11). However, the precise relation between the presence of bacteria and an inflammatory response has not been clearly defined. This is an important issue as it is not known whether the presence of bacteria always causes chorioamnionitis or whether chorioamnionitis is always linked to infection.Many different organisms have been identified from intrauterine tissues after preterm labor using various sampling and culture techniques (12-14), but no clear pattern has emerged from these studies, so it has not been possible to implicate one particular organism or family of organisms as the main causes of preterm labor. Furthermore, it has not been proved that the bacteria present in the vagina are those that have caused chorioamnionitis in pre...

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A microbiologic and clinical study of placental inflammation at term

Cited by 40 publications

References 0 publications

Histologic chorioamnionitis and umbilical serum levels of pro‐inflammatory cytokines and cytokine inhibitors

Histologic chorioamnionitis and umbilical serum levels of pro‐inflammatory cytokines and cytokine inhibitors

Relationship of Amniotic Fluid Markers of Intra-Amniotic Infection With Histopathology in Cases of Preterm Labor With Intact Membranes

Bacteria and Inflammatory Cells in Fetal Membranes Do Not Always Cause Preterm Labor

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